The Effect of Race, Socioeconomic Status, and Collection Center Size on Bone Marrow (BM) and Peripheral Blood Stem Cell (PBSC) Donor Experiences at National Marrow Donor Program (NMDP) Collection Centers

Previous studies have identified risks of collection-related pain and symptoms associated with sex, BMI, and age in unrelated donors undergoing collection at NMDP centers.  We hypothesized that other important factors (race, socioeconomic status [SES], and collection center experience as reflected by numbers of procedures performed) might affect rates of pain/symptoms in donors.  We assessed outcomes by 5 race categories (see table), 4 SES levels, and collection center volume.  The study cohort included 2726 BM and 6768 PBSC donors collected between 2004 and 2009.  Skeletal pain and 10 symptoms were measured and scaled 1-4 as published previously (Pulsipher, Blood 2013 121:197).  Pain/symptoms are reported as peak levels over mobilization and collection (PBSC) or within 2 days of collection (BM) and at 1 week after collection.  Generalized linear mixed models were used to fit logistic regression models with random effects by center; the 3 main effects of race, SES, and center volume were forced into the model, while other donor characteristics were added in a stepwise manner.

For PBSC donors, race was not associated with differences in pain/symptoms during collection or 1-week post donation.  PBSC donors in higher SES levels reported higher peak symptom levels 1-week post donation (p=0.02).  No pattern of increased pain/symptoms was associated with centers that performed smaller number of PBSC collections.  For BM donors, Black males reported significantly higher levels of pain after the procedure.  No differences were noted by SES groups after BM collection.  Different levels of BM collection experience were tested to determine cutpoints; the optimal cutpoint was noted to be 1 or fewer collections every 2 months.  BM donors from centers collecting less than this frequency were more likely to have persistent symptoms (Table 2).

Conclusions:  In general, race and SES have a minimal effect on symptoms associated with donation.  Of note, however, centers performing ≤1 BM collection every 2 months have more symptoms reported after BM collection, and approaches should be developed by low volume centers to address this issue.

Table 1. Multivariate analysis of BM donors for grade 2-4 pain by race/sex:  Odds Ratio (p-value).

 

(overall p-value)	Hispanic	Asian/ Pacific Islander	Black	White	Other/ Unknown
Male (<0.01)	0.75 (0.21)	0.61 (0.10)	1.91 (0.01)	1.0	0.63 (0.09)
Female (0.14)	0.81 (0.30)	1.04 (0.90)	0.57 (0.03)	1.0	1.29 (0.30)

Table 2. Multivariate analysis of BM donors by collection center experience:  Odds Ratio (p-value).

 

BM Collection frequency	Grade 2-4 pain, collection	Grade 2-4 symptoms, collection	Grade 2-4 pain, 1-wk post-collection	Grade 2-4 symptoms, 1-wk post-collection
>1 every 2m	1.0	1.0	1.0	1.0
≤1 every 2m	1.25 (<0.01)	1.41 (0.16)	1.55 (0.07)	2.09 (<0.01)

 

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